Acute Pancreatitis and Diabetic Ketoacidosis in Accidental Hypothermia and Hypothermic Myxoedema

Serial serum amylase and blood glucose levels were measured in 68 hypothermic (rectal temperature 35°C or less) patients, including 15 who had hypothermic myxoedema (serum protein bound iodine 3·5 μg/100 ml or less). Raised amylase levels were found in 34 patients and probably reflected a mild acute pancreatitis. The high amylase levels correlated with low arterial PO₂ levels and significantly with high arterial PCO₂ levels and the base deficit but not with the severity or duration of the hypothermia. The acute pancreatitis does not explain why hypothermic patients with myxoedema have a poorer prognosis than those who are euthyroid. The pancreatitis occasionally contributed to the development, sometimes delayed, of diabetic ketoacidosis, blood glucose levels of over 120 mg/100 ml being found in 20 patients. There was a significant correlation between the raised serum amylase levels and the hyperglycaemia. Hypoglycaemia, sometimes profound, was found in 12 patients.     

The Management of Accidental Hypothermia

Accidental general hypothermia is defined as an unintentional lowering of the body temperature in a previously conscious patient due to exposure. Even mild degrees of hypothermia may be followed by death if treatment is not instituted promptly. Hypothermic patients who are still conscious may rewarm spontaneously. They should not be left unattended and, if the facilities are available, rapid rewarming appears to be the treatment of choice. Unconscious patients who are presumed to have a lower temperature of prolonged duration may not benefit from rapid rewarming. All hypothermia victims showing signs of life are potential survivors, but even with good facilities the mortality rate may be high.     

Influence of Age on Patellar Tendon Reflex Response

Background

A clinical parameter commonly used to assess the neurological status of an individual is the tendon reflex response. However, the clinical method of evaluation often leads to subjective conclusions that may differ between examiners. Moreover, attempts to quantify the reflex response, especially in older age groups, have produced inconsistent results. This study aims to examine the influence of age on the magnitude of the patellar tendon reflex response.

Methodology/Principal Findings

This study was conducted using the motion analysis technique with the reflex responses measured in terms of knee angles. Forty healthy subjects were selected and categorized into three different age groups. Patellar reflexes were elicited from both the left and right patellar tendons of each subject at three different tapping angles and using the Jendrassik maneuver. The findings suggested that age has a significant effect on the magnitude of the reflex response. An angle of 45° may be the ideal tapping angle at which the reflex can be elicited to detect age-related differences in reflex response. The reflex responses were also not influenced by gender and were observed to be fairly symmetrical.

Conclusions/Significance

Neurologically normal individuals will experience an age-dependent decline in patellar reflex response.     

The Validity and Reliability of Motion Analysis in Patellar Tendon Reflex Assessment

Background

The deep tendon reflex assessments that are essential to the accurate diagnosis of neurological or neuromuscular disorders are conducted subjectively in clinical neurology. Our aim was to assess deep tendon reflexes objectively with a new reflex quantification method.

Methodology/Principal Findings

The present study used a motion analysis technique to collect quantitative measurements for both the input and output of normal patellar tendon reflex. Reflex responses were measured as knee angles. The patellar tendon reflexes of 100 healthy subjects were examined using 6 levels of tendon taps, where all the assessments were captured using motion capture system. A linear relationship was found between the experimental maximum tapping velocity and tapping angle (coefficient of determination = 0.989), which was consistent with the theoretical values. Tapping velocities were predictable according to tapping angles. The findings proved the reproducibility of tapping method in producing consistent input. The reflex amplitude was consistent between two randomly assigned groups, and linearly proportionate to the tapping velocity.

Conclusions/Significance

The findings on reflex amplitude indicate that motion analysis is a valid and reliable method of assessing and measuring deep tendon reflexes.